Substance abuse in Pregnancy Flashcards
What is the most dangerous of the common substances used as exposed fetuses generally have serious, permanent impairment?
Alcohol
what is the most common cause of low birth weight in infants and has also been shown to have behavior problems in prenatally exposed children ?
tobacco use
Children of mothers who use drugs during pregnancy are at higher risk for __________
physical, emotional and sexual abuse
abuse of both legal and illegal substances is more common among mothers in ___________ however abuse occurs across all______
Lower socioeconomic groups
all socioeconomic groups
When to consider drug abuse during pregnancy~
Physical evidence of IV drug use
track marks, nasal hyperemia, septal defects
When to consider drug abuse during pregnancy~
High risk historical or social factors
no prenatal care denial of pregnancy family hx of drugs previous child abuse or neglect lack of support system psychiatric problems hx of legal problems
What obstetric complications would lead you to consider drug abuse during pregnancy~
- placental abruption
- unexplained preterm labor
- uterine trauma/abuse
- IUGR
- previous poor birth outcome
Maternal complications from substance abuse~ neurological
cocaine= seizures, postpartum intracerebral hemorrhage
amphetamines, LSD= psychosis
heroin= abstinence syndrome, mononeuritis, polyneuritis, transverse myelitis
Maternal complications from substance abuse~ cardiovascular
cocaine, amphetamines=htn, infarction, cardiomyopathy, arrhythmias, sudden death
IV drug use= bacterial endocarditis
maternal complications from substance abuse~ infectious
IV drugs= Hep B & C, HIV, cellulitis
All drugs= PNA, UTI, STI
maternal complications from substance abuse ~ GI
Cocaine= intestinal infarction
IV drug use= acute and chronic hepatitis
________can be a maternal complication from substance abuse
poor nutrition
Obtaining the substance abuse history
obtain verbally~ no questionnaires
obtain in a private setting away from friends and family
nonjudgmental attitude~ primary interest is child’s welfare not punishing mom
be direct
ask about drug abuse in household members
if admission of drug abuse, ask about dose, routes and duration of use
Hospitals are _______from testing women for illegal drug use without their consent and then reporting positive test results to law enforcement
prohibited
if a neonate presents with unexplained neurological symptoms, a drug test_______without parental consent
Can be done
Urine toxicology time periods for positive test after last use:
Alcohol~ hours amphetamines and cocaine~ 1-3 days opiates~ 2-4 days LSD~ 2-3 days Marijuana~ 7-30 days
urine tests for narcotics are ______ at the time the neonate develops symptoms of withdrawal
negative
meconium and hair screening can be used to detect drug abuse during the _______
second half of pregnancy
*collect meconium sample from first 48 hrs of life
Cocaine (crack) exposure
- what it is = a local anesthetic and CNS stimulant
- believed to be a teratogen and crosses the placenta
- there is no clinically documented withdrawal syndrome from cocaine
- abnormalities in infants exposed to cocaine reflect continued drug effects
S/S of cocaine abuse
premature labor, placental abruption, fetal asphyxia
(many infants show no S/S of affects of cocaine
Cocaine exposure findings may include
LBW IUGR prematurity fetal distress and meconium staining microcephaly anomalies of urinary or GI tracts feeding difficulties irritability abnormal sleep patterns hypertonia
Neurobehavioral findings of infants exposed to cocaine in utero tend to present on what days?
days 2-3
Management of cocaine exposed neonate
use the “S’s “
offer quiet environment
because cocaine is detectable in breastmilk, mothers who have used cocaine recently should not breast-feed
involve child/family services
higher rates of STI’s in women who use cociane ~ consider testing
perinatal cocaine exposure~ long term
changes in IQ or behavior neurobehavioral dysfunction hyperactivity aggression short term attention span problems
